Gawande on Cowboys and Pit Crews
Although hospitals have introduced technology to cut down on mortality, the death rate from surgery has remained high. About 150,000 deaths a year are attributed to surgical complications, but about half are avoidable, Gawande says.
Part of the frustration stems from the fact that although checklists in surgical situations have been proven to reduce complications and costs, hospitals, health systems and physicians, with many notable exceptions, continue to resist them.
"I spend half my time as a surgeon building checklists," he says. "Many industries that grapple with high risk and high failure depend on them, like skyscraper construction or airlines." Boeing, whose top safety engineer is helping on this project, says a good checklist undergoes as many as 50 revisions before it is incorporated into practice.
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"Through use of this successful two-minute checklist, patients had a 47% lower death rate and complications dropped by one third," he says. "VHA has tried it across 74 hospitals; results show an 80% drop in mortality."
"If we had a drug that could cut complications by this much, everyone would implement it, we would have ads all over TV, and lots of people would become rich from it. But it's free, and ironically, that's part of the problem," he said. "Contained in checklists are values very different from what we have in many cases. It requires humility, discipline, and teamwork."
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